A beginner's guide to fills

Zoe · 10-14-2004, 12:19 AM

. . . by that I mean BY a beginner, for other beginners. I had my first fill today. I found other descriptive posts very helpful in answering my questions and allaying my fears, so I thought I'd post a little step-by-step guide of my own, in case it helps any other readers who wonder what a fill involves and feels like.

First of all, I should mention that I was banded in Mexico and am getting aftercare in the US. This was made relatively easy because (1) I live in a big city, and (2) one of my surgeon's former students has a large, well-established LAP-BAND^® practice here, and this doctor agreed to do my fills for a fraction of what he usually charges other docs' patients ($250 vs. $1000).

My surgeon, Dr. Rumbaut, had told me that I'd probably want a fill after six weeks; no matter what, he said, I shouldn't get one any earlier, and I may not need one until later. The day after my six-week anniversary I started feeling hungrier, and was able to pack away more food than before. I figured I should at least get checked out.

My appointment was at 2 pm today. I arrived at Dr. Horgan's posh Michigan Avenue office 15 minutes early, completed a new-patient info form and a questionnaire about obesity-related health problems and whether I'd noticed a change since banding, and just after 2 pm I was shown to an examination room where an assistant, Michelle, weighed me on a body-composition scale (photo #2 below) and took my pulse and blood pressure. I was asked to change into a giant hospital gown. (I should mention that both the gowns and many of the waiting room chairs are sized to accommodate very large people. Someone was thinking ahead.)

I asked Michelle if I could take pictures, and after an initial hesitation she said yes, and suggested that I ask for a duplicate copy of my fluoroscope image. She then led me to the room holding the machine (photo #1). In a few minutes Dr. Horgan and a male technician came in and briefly explained the procedure. I should mention that, except for the gown replacing my blouse, I was wearing all my clothes. Dr. H asked me to lower my trousers so that he could get access to the port, which in my case is a few inches above my left hipbone. He guided me into position in front of the fluoro machine. I remained standing the entire time, and never actually touched the equipment. To my disappointment I realized that I would not be facing the image of my belly, which (weirdo that I am) I was kind of looking forward to. So far, easy as could be, no discomfort of any kind.

Next, Dr. H sprayed a "freezing agent" near my port; I forgot to ask what it was. The freezing agent really did feel cold, and it looked as if a half-dollar-size spot on my belly had been in the back of a refrigerator that needed defrosting, little ice crystals and all! Still no discomfort. He asked me to take a swig of a thick white barium drink. It wasn't as bad as I expected (the technician joked that Starbucks was selling it, but that's pushing it) -- just a little chalky, with a slight vanilla scent and taste. The barium makes its way down the esophagus to the stomach (and, later, beyond) and allows the technician to see a rough outline of the patient's insides.

At this point I noticed Dr. H preparing a big hypodermic needle. Yikes! After adjusting my position, he aimed right for the port. I won't lie -- I definitely felt it. I know many other bandsters don't even notice the needle go in, but not me. However, it wasn't bad, and I think if I hadn't expected the entire procedure to be a total breeze, it probably wouldn't have bothered me at all.

Unfortunately I couldn't take a picture of the needle going into my belly, because I had to hold my arms straight down at my side -- and I sure didn't want to ask the doc to drop that giant needle and pick up my camera!

I think it was at this point that I took another swig of the barium drink so they could monitor the response of the band and my body. That needle was definitely in, and the doc injected some saline. I blithely thought I'd get 1.5 cc, since that seems to be average, and so far I'm your average bandster. Nope! First I was injected with 1.4 cc, then as the two guys watched the fluoro, Dr. Horgan said, "Oh, that's too much. Let's take out .2." So he did. So here I am with 1.2 cc of saline in my Inamed band, which Dr. H said should give me good restriction.

I did get a copy of my fluoroscope picture (#3). Hey, I've had less flattering photos! By the way, the small bit highlighted by the ink rectangle in the left image is my band, and the dark hairy-looking bit is the barium drifting through my stomach. I had to ask.

Well, I'm on liquids for 48 hours, then onto the real bandster eating routine. Dr. Horgan said I should lose two pounds a week. When I said I didn't mind losing more slowly, he was adamant, and said if I didn't lose those two pounds every week I should give him a call. He wants me to see him in another two months -- sooner if I have trouble. And in case this initial fill is too tight or too loose, I can have it readjusted for free as long as I do so within a week.

One last thing I can't resist adding: Dr. H asked me why I had surgery in Mexico. "Financial concerns," I said. "What kind?" he asked. I was taken aback. "Well, it's a lot cheaper in Mexico," I shrugged. He didn't have a response to that!

Good luck to everyone getting their first fill -- it's not bad, and the whole thing, including paperwork and tests, took about 45 minutes.

Vera · 10-14-2004, 12:34 AM

Dr H is one of the best! From what I've read he just un-twisted Nicci's stomach. The pain she's been feeling since banding was intence. Her doc said to remove her band. But Dr. H fixed her up.
Glad to see all the documentation!
I would have replied the same to his question about going to MX, and I have.

Zoe · 10-14-2004, 12:35 AM

The fluoro machine. See that U-shaped device with the black circle attached to one arm of the U? That's where you stand, your back to the black circle. The fluoroscope in effect takes a picture of your body, with the black circle representing the lens area. The image of your body appears on the upright console.

Zoe · 10-14-2004, 12:39 AM

The body-composition scale -- calculates not only BMI but the percentage of fat in your body and your basal metabolic rate (how many calories you burn just vegetating), among other things.

Zoe · 10-14-2004, 12:46 AM

My fluoroscope images. I had no idea what anything was -- with the exception of my giant spine, the shadowy column barely visible beneath the big black barium-filled blob at upper left (the lower part of that is my stomach pouch). Note the barium cascade, looking like a hairy black jellyfish.

Vera · 10-14-2004, 12:58 AM

perfect pics!
When you move and the barium flows, you see it on the screen "live"

Katie328 · 10-14-2004, 11:23 AM

wow thats great! Not having my first fill yet, that helps me to know the process a little bit better...i was just picturing my dr. with a big needle to go through all of my "chub" and injecting me...THanks ZOE!!!!!

katie

vtobon · 10-14-2004, 01:40 PM

Sooo did he charge you $250. I also live near Chicago. I was looking for a doctor. I talked to a few of Dr. Horgan's emploees and they told me $1000.

**Iluvharleys** · 10-14-2004, 01:47 PM

Great pictures Zoe! Thanks for showing them to us.

adoorme9 · 10-16-2004, 10:12 AM

hi ,zoe, thanks so much ,for your intake of info. on the fill, it was scarey to me , but, worth , it, your pictures were great too. thank you for being so thougthful, to all the bansters. one question , how long did it take, to get fill , the whole thing. :nervous ,i may, be getting it done too. hope not.
sincerely.
margie

QueenMichelle · 10-16-2004, 11:46 AM

helath insurance does not cover the cost of your fills???????

10-16-2004, 02:29 PM

While going through the pre-banding process (over a year and a half ago), my Dr. allowed me, with the permission of the patient, to watch someone get a fill. It seemed so effortless and no pain or discomfort was ever proclaimed by the patient. I was glad to have had the opportunity to watch. I think that will help when I have my first fill next Friday.

New Hope · 10-16-2004, 11:57 PM

Mylailie, I think that is an excellent idea for a LAP-BAND^® dr. to do! I'm a "show-me" kind of girl.

leatha_g · 10-17-2004, 12:33 AM

Quote:

Originally Posted by QueenMichelle

helath insurance does not cover the cost of your fills???????

Some insurances do, some don't. Mostly, I think it depends on how they are coded and whether it paid for your surgery or not.

In my case, my doc has a deal where any care within the first 3 months after surgery is considered part of the deal, after that, we'll see. My insurance DID pay with my first band.

Marimaru · 10-17-2004, 02:07 AM

Zoe, that's a great post you've done. I had my first fill already, and read all I could on it, but I was SO nervous. I had all these visions in my head of having more of the same pain from the surgery, which wasn't bad at the time, but I wasn't looking forward to a second round :P. I felt so silly when I was all done with my fill.

At Dr. Kuri's office they have the screen in a place where you can see it. That was pretty neat. There they do the first barium swallow under floro, then you go lie down and they do the fill, then you go back under the floro again for another swallow. Also instead of a freezing agent they used a tiny tiny needle to inject something to numb the area. I felt the needle and the port connect, but I didn't feel the needle in my skin at all.

Michelle- I have a feeling that if your insurance is going to cover the surgery, they'll cover the after care, but many of us are self pay, in which case we gotta pay for our fills as well :).